The Elms Residential Care Home

Updated 8 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Elms Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Elms Residential Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was no registered manager in post.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed information we had received about the service. We sought feedback from the local authority who commission with the service and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used all this information to plan our inspection.

During the inspection

We spoke with 7 people and 10 relatives/visitors about their experience of the care provided. We carried out observations within communal areas to understand people’s experiences of the care provided.

We spoke with 9 members of staff including the deputy manager, the provider’s operations director and their quality assurance manager, 3 care staff, a member of the housekeeping team, the chef and a member of agency staff. We received feedback from 2 visiting healthcare professionals who worked with the home.

We reviewed a range of records. This included 4 people's care records and 11 people’s medicines records. We also looked at arrangements for administering, storing and managing medicines. We looked at a selection of monitoring records such as fluid input and output charts and repositioning charts. We looked at 2 staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 8 February 2023

About the service

The Elms Residential Home is a residential care home providing personal care and accommodation for up to 27 older people, some of whom have dementia. The service is made up of a four-storey house with en-suite bedrooms and communal facilities. At the time of our inspection visit there were 21 people receiving care.

People's experience of using this service and what we found

Risks to people's health had been assessed and identified, but staff were not always aware of people's risks to keep them safe. Records did not demonstrate safe practice and enable effective monitoring of risks to take place. Staff had not always recorded that people’s topical medicines had been applied to provide assurance they were given in accordance with the prescriber’s instructions.

Staffing was maintained at the level the provider had assessed was needed. However, due to the high numbers of new and agency staff, shifts were not always staffed with care workers who had extensive knowledge of people's individual needs. The provider did not have effective systems to confirm the identity of agency staff and ensure they had the appropriate training and employment checks in place.

Staff understood their role in reporting any safeguarding concerns. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There had been recent and significant changes in managers and key senior staff at the service which had impacted on some quality standards. Systems and processes to monitor and improve the quality of care provided had not been effective in identifying the areas of improvement we found during our visit.

Despite the issues we identified, people and most relatives were happy with the care provided. Relatives told us they were kept informed about their family member’s health and that staff worked with other healthcare professionals to improve outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 6 December 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and the culture within the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Elms Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches of regulations in relation to the management of risks and the governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow-up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.